The clinical characteristics analysis of low-grade endometrial stromal sarcoma
Objective To investigate the clinical features of low-grade endometrial stromal sarcoma(LGESS)which af-fect its preoperative diagnostic accuracy.Methods Data of 52 patients with LGESS diagnosed and treated in the Gyne-cology and Obstetrics Hospital Affiliated to Zhejiang University School of Medicine from January 2013 to December 2022 was studied retrospectively.These patients were divided into the diagnosis group and the misdiagnosis group according to whether they were diagnosed with endometrial stromal sarcoma or uterine malignancy before surgery.We compared their general status,clinical symptoms,laboratory examination,imaging examination,pathological examination and surgical sit-uation,analyzed their correlation with preoperative diagnosis and misdiagnosis,and followed up the survival and recur-rence of these patients.Results Of 52 cases(44.2％),23 were diagnosed and 29 cases(55.8％)were not diagnosed before surgery.Patients with younger age,abnormal vaginal bleeding,smaller maximum diameter of tumor,protrusion of the lesion into the uterine cavity and preoperative histopathological examination were more likely to be diagnosed before surgery,the difference was statistically significant compared with the no-diagnosis group(P=0.009,0.027,＜0.001,＜0.001,＜0.001,respectively).The diagnostic sensitivity of hysteroscopy plus pathology for LGESS was 94.4％.In the no-diagnosis group,41.4％of the patients underwent unprotected lesion fragmentation,and 51.7％of the patients underwent a second operation due to the improper scope of the first operation.Conclusions LGESS has a high rate of preoperative misseddiagnosis.For patients with abnormal vaginal bleeding or protrusion of the lesion into the uterine cavity,hysteros-copy with pathological examination is feasible before surgery,which can reduce the misseddiagnosis rate.Patients with-out abnormal vaginal bleeding,larger tumor diameter and no protrusion of the lesion into the uterine cavity are likely to be misdiagnosed before operation.Ultrasound and magnetic resonance imaging can be used for further diagnosis.Non-protective laparoscopic lesion fragmenta-tion should be avoided as far as possible,and intraoperative frozen pathological examination can prevent improper surgi-cal scope.
万方数据
维普
